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Pupils Not Dilated In The Dark?


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#1 wpcoe

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Posted 2010-05-24 23:22:29

What would cause one's pupils to not dilate properly is a darkened room?

Off and on for about the last nine months or so, I've been subject to occasional headaches that seem to be centered behind my right eye. "Occasional" meaning maybe once in six weeks if I'm lucky, or sometimes a couple times in a single week.

The headaches do not respond to pain killers like aspirin, acetaminophen or tramadol (I even tried some codeine I had left over from a previous bout of bronchitis with persistent cough), though usually after a good night's rest, my headache goes away.

About a week ago I had one headache that did not disappear the following morning, but it did disappear after the second night. Other than that one time, I can count on being headache-free the next morning. The headache is rather sharp, but not overbearingly so, nor is it throbbing.

Today, I've been subject to yet another headache. This one was slightly different in that it seemed to be centered behind my left eye, instead of my right eye. This evening, for whatever reason, I looked into my eye in a mirror in a semi-dark room and realized my pupils were not dilated as I expected. This is obviously subjective as I have no measurement of dilation from another time, but dimming the lights as dim as I could and still see my eyes in a mirror, the pupils did not seem to dilate.

Making the quantum leap and assuming this (non-dilated pupils in the dark) is related to my headaches, any ideas what would cause it? Since it's late in the evening, I'm not motivated to rush to the doctor, and odds are that I'll not have the headache or the eye symptom in the morning.

What type of doctor should I consult? An ophthalmologist? A neurologist? Somebody else?

Is it worth seeing [whatever doctor is appropriate] when I have neither the eye symptom or the headache? i.e. Should I wait for the next headache?

#2 dumball

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Posted 2010-05-25 10:32:22

Cause and effect can often be tested for without the symptoms being present , get yourself to a good eye doctor for tests , talking on here will achieve nothing to your advantage , but then again , it is your body you are talking about .

#3 Sheryl

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Posted 2010-05-25 12:02:05

First of all, I would not worry about the pupils. You cannot properly check them the way you have been trying to do; it needs to be done by suddenly flashing a light into the eye and looking for an imemdiate constriction (hard if not impossible to do on yourself). How widely they dilate in what degree of darkness varies by individual and is not particulalry meaningful, it is the ability to rapidly constrict in response to strong light and in any event if that were not normal you would not be on line posting.

For the headaches, if you want to consult someone, see a neurologist who speacilized in headaches, eg Dr. Erawady Mitrabhakdi at Bangkok Hospital, Dr. Nijasri Charnnarong at Bumrungrad, DR. ANAN SRIKIATKHACHORN at BNH. There are probably also some at Samitivej but cannot determine from their website, if you want to go there then call and ask which neurologists have special interest in HA.

But before consulting a neurologist you might want to consider (if you have not already) such obvious causes as:

- too little sleep

- too much alcohol

- too much caffeine

- low blood sugar rebound after intake of too much sugar (in form of alcohol, or highly processed carbs, or sweets)

- eye strain (can get a free vision check at any optical shop)

or any combo of the above. Tool ittle sleep + too much coffee gives me headaches almost exactly as you describe...

#4 FBN

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Posted 2010-05-25 12:08:50

Tramadol can cause the pupils to narrow and not respond normally to darkened environment.
If they are equal, this is probably the cause. Unequal size pupils are definitely a concern or pupils that resond differently to a light shone into the eye.
If the headaches occur frequently, have the headaches checked out by a neurologist as suggested.

In the mean time avoid those factors mentioned by Sheryl above.

#5 wpcoe

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Posted 2010-05-26 16:29:58

Thanks Sheryl/FBN.

I will probably finally get around to consulting a doctor one of these days, now that I know to focus on neurologists who specialize in headaches.

This past experience a couple days ago did involve tramadol, so eases my concern about my pupils. I still take some sort of analgesic when I get the headaches ... *occasionally* they provide relief, but usually not.

Of the risk factors Sheryl listed, the sleep and caffeine issues are most applicable. My sleep habits are irregular, to say the least. I tend to let my body dictate when I should sleep. If I go to bed at 10pm and am still lying awake with my mind racing at 1130pm, I get up. If I feel like I need a nap at 200pm, I got to bed, and if that means 5 or 6 hours of sleep, then so be it.

I've been on a coffee habit recently where I drink a couple large coffees (made at home) per day. My norm, if you can call it that, would be to have one or two a week.

So, overall, I'm not alarmed, just irritated by the headaches when they occur. And, as I said, "one of these days" I'll get around to medical evaluation.

I miss the medical care options of Bangkok. When I lived there, I was less likely to delay a medical consultation about even a minor concern. BNH was my preferred hospital. Here in the Pattaya area, I'm not comfortable with the medical facilities/sfaff. Even having a recent overnight sleep evaluation at Bangkok Hospital Pattaya left a bad taste in my mouth, so to speak.





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